All diseases exist on a spectrum. Although the pathophysiology and relative illness of patients on the spectrum are different, we often apply the concepts of management of one of the spectrum to the other end. This can be extremely deleterious to our patients. For example, we cannot treat CHF exacerbations, acute pulmonary edema and cardiogenic shock with the same approach (i.e. no role for loop diuretics early in APE). Thin-slicing disease into a spectrum allows us to tailor our management to our patients and maximize good outcomes.

This talk will outline the current state of play in terms of the 'silver tsunami' of elderly patients attending our EDs. What the evidence is for managing them effectively within the ED, and how we could manage them better. It will focus on the effective and efficient delivery of services for the elderly within the ED, the need for training and specialist skills and research to deliver improved care.

The key to dystopian literature is the backstory. These brutal, terrifying worlds are grim forecasts of the future, spawned from the choices and actions of the present. In critical care medicine we make rafts of decisions everyday - not all of them ideal. This talk looks at a projection into the future, both fictional and real, based on those small decisions, actions, and processes.

The farm is a dangerous workplace. Accidents have an unusually high morbidity and mortality not only for the worker but also his/her family members. The reasons are multi-factorial but are the result of a complex interaction of environment, equipment, and human factors. Tractors are involved in the vast majority of agricultural deaths. No other industry uses 70-year-old machinery operated by workers whose age ranges from 10 to 90. How can we prevent such incidents?

Today’s presentation is from my viewpoint as a prehospital physician (who is a wannabe farmer & tractor mechanic) and longtime resident of an agricultural community. We will examine the details of a life threatening accident involving one of my neighbors which perfectly illustrates the multifaceted nature of agricultural trauma

In the busy world of emergency medicine it's easy to focus on the here and now, there is always something that demands immediate attention. What of the future? How will demographics, workforce, technology, finance and politics affect the practice of emergency medicine? This talk explores these issues and charts a future that will be very different to today.

John Hinds' tragic death has affected many people all over the world. In the inaugural John Hinds Plenary session at SMACCDUB, John's partner Janet and his mentor Fred MacSorley celebrate John's life in a fitting tribute to the man that has become a legend.

Lets explore dogma and myths about the knowledge and skills of 'resuscitationists', and the way we think we maintain and improve our skills. BLS and trauma team leadership will come under the spotlight - we often don't do what we think we do. Resuscitationists are exceptional people - but not necessarily in the way we think we are. And finally - some thoughts on what we'll leave behind as resuscitationists... with a tribute to John Hinds

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

As our population ages, the complexity of patients seeking care in the emergency department will increase dramatically. Chronic and terminal diseases will be ever-present but increasingly in patients also negotiating challenges like functional and cognitive decline. While their needs are different, in many hospitals, it is business as usual. A highly skilled and well-intentioned staff stands ready to deploy a limitless supply of diagnostic and therapeutic options designed to help patients live longer, not necessarily better.

Relying on default pathways that prioritize life-prolongation at the mercy of comfort and dignity has already left many patients and doctors feeling unsatisfied, while wasting precious healthcare resources. The future should not be more of the same.

If a new and better clinical road is to be paved in the future, it will be with the aid of palliative care, a specialty, philosophy and movement in medicine. Getting patients better access to palliative care should be a priority for our specialty. For some, this will mean partnering with existing palliative care specialists and hospices. Unfortunately, for most of us, the palliative care workforce will never be able to match the increasing demand created by our patients. This means that we must all do the hard, but incredibly rewarding work of learning a basic palliative care skillset. No pressure but the future of healthcare depends on it!